Smoking Kills….Equipment, Too

A call from an adjuster who was frustrated about having to replace a $9,000 low air-loss mattress after only two years prompted a full investigation of an injured worker’s ongoing medical care and rehabilitation program.

The claimant was a 48-year-old man who was severely injured in 1982 in a fall while working on a construction job.

Deemed quadriplegic with C1 to C4 fractures, he has no use of his legs and minimal use of his arms, and uses a power chair. He has had chronic wounds for the past 15 years and has been treated at numerous clinics. As his health deteriorated, he has spent more time in bed, and turning him is an issue due to his weight.

The mattress should have lasted at least five years. It was a good brand and the right recommendation for the claimant, who needed wound care. Using air as the support structure, low air-loss mattresses minimize pressure on the body and circulate air across the claimant’s skin. This reduces moisture and facilitates wound healing while it prevents pressure ulcers.

So what was the problem? Was it a manufacturing defect, operating error, or a maintenance issue? The first clue came when I entered the claimant’s home and was engulfed in a wall of cigarette smoke.

Gumming Up the WorksThe bedridden claimant was a chronic smoker, as were the other four adults living in the house. Second-hand smoke contaminates equipment just like it does the human body. The poisons and chemicals in the smoke can damage any equipment, but air mattresses are especially vulnerable.

A vacuum pump pulls air from the room and holds it inside the mattress until the air gently bleeds out through tiny holes in tube-like chambers. In this case, the pump was sucking in and retaining second-hand smoke.

Smoke was permeating everything inside the mattress and causing a sticky residue. Anyone who has been in the home of long-term smoker knows the walls get sticky. You can scrub and paint walls, but this type of mattress is a breathing product and it was constantly taking in toxic, chemical-laden air.

The sticky residue was adhering to the pump, blower blades and filter. It was gumming up the electronic valves so they could not open and close properly. More importantly, the residue would eventually build up in the tiny holes that emit air onto the patient’s skin—like calcium build-up on a steam iron—restricting or blocking the point of exit altogether.

Reduced air flow was causing the engine to work harder and fail faster than it should. Trapped smoke was circulating inside the mattress, its nicotine drying out the vinyl, plastic and nylon inside the chamber, just as it dries out the skin. The lining was becoming brittle and cracking.

The air that was managing to trickle out was noxious, second-hand smoke, comprised of 4,000 chemicals—at least 200 known poisons—and many carcinogens. The claimant’s skin was trying to expel these toxins, but it was a tough fight because of the constant exposure to poisons.

I wasn’t surprised to see that the patient’s wounds were not healing. The pressure ulcers looked like they would almost heal, but then they would break back open. The smoke was hindering the physical recovery of the claimant and negatively impacting the therapeutic benefits of the equipment.

This case raised a number of moral and operational dilemmas for the claimant, provider, claims adjuster, and medical personnel. Should a provider have to pay for equipment that has a shorter-than-normal life cycle because the patient or caregiver smokes? Does it make more sense to use a foam mattress that will not be as adversely affected as the air mattress? Should a less expense air mattress be substituted, and simply replaced more often?

What of the patient? Should he be moved to an assisted living facility where smoking is not permitted? Does it make sense to pay for nicotine patches or other smoke cessation therapies? Would the patches or therapy by covered under workers’ compensation?

A Positive OutcomeFortunately, in this case the injured employee came to understand how second-hand smoke was damaging his mattress and committed to stop smoking. Of course, all the other people in the house needed to stop smoking around the bed, too.

The dangers of smoking and second-hand smoke are well known. Wounds, fractures and back fusions take longer to heal, physical therapy is more difficult, and smokers are susceptible to upper respiratory infections.

Payers need to recognize that smoking takes its toll on equipment just as it does the human body. If the claimant, caregivers and/or other close family members smoke, adjusters should anticipate and reserve for higher costs for both medical care and equipment.

It may make sense for adjusters to add a smoking checklist to the equipment selection process. (See the sample checklist on page 7.) If the claimant smokes, consideration should be given to mattress options. Foam may last longer, but may not be recommended for wound care. If a low air-loss mattress is indicated, the adjuster might seek out the model that takes in the least amount of air.

Asking the right questions will help ensure that the most cost-effective and therapeutic products are recommended.

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